Assisting in Surgical Procedures CH11 Flashcards
The term minor surgery can be defined as:
a) a simple procedure with minimal risk
b) any surgery that is done using only local anesthetic
c) any surgery that is not required to be performed in a hospital
d) a simple procedure that can be performed by an assistant
a) Simple procedures that have minimal risk may be considered minor.
Which of the following could be considered minor surgery?
a) cataract extraction
b) corneal transplant
c) chalazion removal
d) enucleation
c) The chalazion excision is a minor procedure. The other procedures listed are not simple
and have at least moderate risk.
“Incision” refers to:
a) cutting out tissue
b) cutting into tissue
c) suturing tissue
d) giving an injection
b) Incision refers to cutting into a tissue as compared to tissue removal.
“Excision” is defined as:
a) cutting out tissue
b) cutting into tissue
c) suturing tissue
d) giving an injection
a) If tissue is removed, the procedure is an excision.
The procedure that corrects the inversion of the lower eyelid is:
a) chalazion removal
b) ptosis correction
c) entropion repair
d) ectropion repair
c) An inverted lower eyelid is an entropion. It is corrected to prevent corneal irritation and
scarring from constant rubbing by the eyelashes.
A surgical schedule would describe the procedure to correct drooping of the upper
eyelid as:
a) ptosis correction
b) chalazion removal
c) scleral buckling
d) trabeculectomy
a) Ptosis is a drooped eyelid. It might be repaired for cosmetic or visual reasons.
The procedure for removal of a fleshy encroachment onto the cornea is a/an:
a) ectropion repair
b) pterygium excision
c) hordeolum excision
d) scleral buckling
b) A pterygium is a fleshy growth that extends from the conjunctiva onto the cornea. It is
removed because it can grow across the front of the cornea, impeding sight.
All of the following might be done after the excision of a possible skin cancer except:
a) placing disposable needles and blades in an approved sharps container
b) placing the removed tissue in a specimen bottle for biopsy
c) proper disposal of contaminated disposables
d) proper disposal of all removed tissue
d) Any tissue that might be cancerous is sent for biopsy, not disposed of.
An ungloved person sets up a sterile tray by carefully “dumping” sterile instruments and materials onto the tray without contacting them. This preparation is known as:
a) the “no touch” method
b) unacceptable, as it is not sterile technique
c) standard precautions
d) the sterile method
a) The “no touch” method of setting up a sterile tray for minor surgery is acceptable as long as there is strictly no contact with anything that touches the tray.
A sterile tray for a chalazion removal might include:
a) chalazion clamp, blade, forceps, and curette
b) eyelid speculum, blade, and forceps
c) chalazion clamp, needle holder, and cannula
d) eyelid speculum, blade, forceps, and curette
a) A chalazion clamp, blade, forceps, and curette might all be used for a chalazion removal. An eyelid speculum, cannula, and/or needle holder are not generally required.
A sterile tray for a lacrimal evaluation might include:
a) lid speculum, punctal dilator, and lacrimal stint
b) clamp, needle holder, and curette
c) forceps, punctal dilator, curette, and lacrimal cannula
d) medicine glass, punctal dilator, syringe, and lacrimal cannula
d) A lacrimal setup would include a medicine glass (for saline), punctal dilator, syringe, and
cannula for lavage (irrigation).
In addition to the sterile tray for a lacrimal evaluation, the setup for a procedure to
open a blocked tear duct would include:
a) blunt needle
b) set of probes
c) cautery unit
d) electrolysis unit
b) A probe is the wire-like instrument that is passed through the punctum and canaliculus,
then pushed through the blockage.
A sterile tray for any growth removal will probably include:
a) lid speculum, forceps, curette, and suture material
b) scalpel, scissors, forceps, needle holder, and sutures
c) curette, chalazion clamp, forceps, and scalpel
d) probe, forceps, scissors, and needle holder
b) Any growth removal will probably require a scalpel, scissors, forceps, needle holder, and
suture material. A lid speculum might be used, but a curette and chalazion clamp are for
chalazia and a probe is for lacrimal procedures.
Match the following:
cryo
cautery
electrolysis
laser
a) uses focused amplified light
b) uses electrical impulses
c) uses cold
d) uses heat
cryo - C) uses cold
cautery - D) uses heat
electrolysis - B) uses electrical impulses
laser - A) uses focused amplified light
All of the following can cause stains on surgical instruments except:
a) failure to rinse off detergents
b) residue from sutures
c) minerals in the water source
d) dried blood
b) Okay, I confess, I made up answer b. All the rest can cause staining.
Surgical instruments should be lubricated:
a) only when they seem to stick
b) only if cleaned in an ultrasonic unit
c) after every use
d) after every fifth use
d) As a general rule, lubricate surgical instruments after every fifth use.
Which of the following is true regarding ultrasonic cleaners?
a) They effectively sterilize surgical instruments.
b) Scrub instruments before placing them in the unit.
c) Instruments should not touch while in the unit.
d) Glass cannot be placed in the unit.
c) Ultrasonic cleaners do not sterilize, you do not have to scrub first, and you can put glass
in them. But the instruments should not touch.
The premise behind refractive surgery is to change the refractive power of the eye by:
a) changing the eye’s refractive index
b) eliminating astigmatism
c) altering the eye’s focal length
d) transposing the refractive error
c) The focal length of the eye (or of any lens/lens system) is the distance from the lens
system to the focal point, where light is focused. Refractive surgery seeks to alter this in order to put the focal point directly on the retina (ie, macula).
Laser refractive surgery seeks to correct a refractive error by:
a) altering the shape of the cornea
b) altering the shape of the retina
c) improving the tear film
d) inserting a retinal implant
a) The cornea accounts for most of the refractive power of the eye. It is also accessible, as opposed to the other parts of ocular media, except for the tear film. Changing the cornea’s shape (flattening or steepening) alters the refractive error.
To correct myopia with laser refractive surgery, the goal is to:
a) steepen the corneal center
b) flatten the corneal center
c) eliminate minus power in the eye
d) eliminate astigmatism
b) Flattening the cornea’s center moves the eye’s focal point back toward the retina. In
myopia, the focal point falls somewhere in the vitreous. (Note: Regarding answer c, the
myopic eye has too much plus power, which is why we neutralize it with minus.)
In which of the following refractive procedures is a corneal flap created and laser used
to sculpt the underlying tissue?
a) intrastromal rings
b) radial keratotomy (RK)
c) laser-assisted in-situ keratomileusis (LASIK)
d) photorefractive keratectomy (PRK)
c) In LASIK surgery, a microkeratome (a keratome is a surgical knife/blade used to incise the cornea; a microkeratome is small and capable of making very precise incisions) is used to cut a thin flap in the top-most corneal layers. The excimer laser is then used to sculpt the underlying tissue to correct the refractive error. The flap is then put back into place, over the ablated area.
Laser refractive surgery is performed with which type of laser?
a) argon
b) excimer
c) YAG
d) krypton
b) The name excimer is derived from “excited dimer.” This laser uses ultraviolet radiation
that breaks or photoevaporates chemical bonds between tissues and is ideally suited for
work on the cornea.
All of the following are forms of laser refractive surgery except:
a) RK
b) PRK
c) LASIK
d) laser-assisted subepithelial keratomileusis (LASEK)
a) In RK, the surgeon uses a diamond blade to alter the cornea’s shape.
In LASIK, which corneal layers are excised as part of the flap?
a) epithelium
b) epithelium and Bowman’s layer
c) epithelium and Descemet’s membrane
d) endothelium and stroma
b) In LASIK, a microkeratome is used to create a flap of the epithelium and Bowman’s
layer (and, technically, a bit of the stroma). The laser is then used to sculpt the underlying
stroma.
Which of the following allows the surgeon to customize laser refractive surgery during
the procedure?
a) wavefront LASIK
b) aberration-free LASIK
c) LASIK IOLMaster (Carl Zeiss, Jena, Germany) software
d) LASIK corneal keratometry
a) Wavefront technology creates a rough map of the patient’s eye, allowing very precise
control and treatment during the refractive procedure. The idea is to reduce aberrations,
thus reducing side effects such as glare, haloes, and blur. The other answers are bogus.
Postoperative instructions following LASIK surgery would include all of the following
except:
a) do not bend over
b) shower from the neck down
c) wear a shield over the operated eye at bedtime
d) do not rub the eye
a) There is no restriction on bending over after LASIK surgery. Otherwise, patients are told
to avoid water/sweat in the eye, do not rub the eye, wear the shield at bedtime, avoid smoke,
and not to wear make-up. The duration of these restrictions varies.
Matching: Match the procedure to the description; items may be used more than
once:
-used to treat corneal scars
-involves use of a keratome
-corneal epithelium removed
-corneal flap
-very thin corneal flap
-treats some types of corneal dystrophy
-corneal flap includes some stroma
-routine use of a postoperative bandage contact lens
a) PRK
b) LASIK
c) LASEK
d) Phototherapeutic keratectomy (PTK)
- used to treat corneal scars - D)
- involves use of a keratome - B) & C)
- corneal epithelium removed - A) & sometimes D)
- corneal flap - B) & C)
- very thin corneal flap - C)
- treats some types of corneal dystrophy - D)
- corneal flap includes some stroma - B)
- routine use of a postoperative bandage contact lens - A) & D)
The sterile field is an area that is considered to be:
a) disinfected
b) free of chemicals
c) free of microbes
d) sanitized
c) The sterile field is considered to be free of microorganisms. Disinfection is not sterility;
it does not remove the most resistant microbes. Sanitization means that the number of microbes has been reduced to a “safe” level.
The sterile field would include all of the following except:
a) sterile, gloved hands
b) eye drop bottles
c) the drape around the surgical site
d) the instrument tray
b) While many minor ophthalmic procedures would include the use of eye drops before,
during, or after the surgery, the bottles are not sterile. The sterile gloved hands of the surgical team, the exterior of the eye drape, and the instrument tray (with sterile instruments on
a sterile drape or towel of some sort) are each part of the sterile field.
If an unsterile object touches anything in the sterile field, the field is:
a) immediately covered with another drape
b) immediately rescrubbed
c) considered contaminated
d) still adequate and surgery may continue
c) There is no such thing as “almost” sterile; if an unsterile item contacts the sterile field,
the field is considered contaminated.
Techniques used to prevent preoperative, intraoperative, and postoperative microbial
infection are collectively termed:
a) clean
b) aseptic
c) sanitary
d) health standard
b) Aseptic technique is used to prevent contamination by infectious microorganisms. The level of asepsis varies according to the procedure, ranging from clean to aseptic to sterile. Clean technique is used for noninvasive procedures such as tonometry. Aseptic technique is applied to minor surgical procedures. Sterile technique is used in major surgery, where exposure of tissues might be more deep and lengthy. (You can see that “aseptic technique” has a rather double meaning; be sure to read questions carefully.)
The purpose of aseptic technique is to:
a) reduce the number of chemicals present
b) ensure proper safety measures
c) reduce the chances of wound infection
d) ensure proper ventilation
c) The purpose of aseptic technique is to eliminate microorganisms that could potentially cause infection.
Steps in a minor surgery procedure include all of the following except:
a) disinfection of the patient’s skin
b) setting up a sterile tray
c) administering topical or local anesthetic
d) sterile gowning of surgical personnel
d) Sterile gowning is not required for minor surgery, as a rule.
In minor surgery, the assistant might remain ungloved. In this case he or she:
a) must not disinfect the patient’s skin
b) must not touch any nonsterile area
c) must not touch the sterile field
d) must not apply eye drops
c) If an ungloved assistant touches the sterile field, the field becomes contaminated.
“Laser” stands for:
a) light amplification to stimulate emission of radioactivity
b) light amplification to stimulate emergence of radiation
c) light absorption to simulate effective radiation
d) light amplification by stimulated emission of radiation
d) Light amplification by stimulated emission of radiation is the basis of the acronym.
The basic function of any laser is:
a) tissue destruction
b) tissue sculpting
c) creation of an opening
d) to decrease pressure
a) Regardless of laser type, mode of action, or treatment type, a laser is used to destroy
tissue. The purpose may be to open (as in laser capsulotomy), cause scarring (the theorized action of laser trabeculectomy), or seal (as in punctoplasty or diabetic retinopathy). Each of these involves tissue destruction, whether by heat (photocoagulation), vaporization, cut-
ting (photodisruption), or breaking down the chemical bonds of tissues (photoablation).
